what are revision options after RNY? NOT Stomaphyx or Restore

What does the surgeon do to revise a RNY?  I tried the Restore and it did not hold.  I have a huge anastamosis dilation but a fairly normal sized pouch.  Form the old operative report the bypassed limb isn't as much as the research I've done indicates it should be. My original surgeon bypassed only 60cm not the 100cm that I've read is the usual length bypassed.  Is this what they do ? I mean extend the limb and tighten the anastamosis site?  Anyone out there know?

Not that I'm an expert but I can offer an opinion. #1 You can have an extended RNY or DS version of the surgery where they can bypass more..which would give the likihood of more diarrhea. However, with this..it would be major surgery - if that is what you would be looking for. #2 You can look into the schlerotherapy, which is a agent that creates scar tissue around the stoma. This will allow food to stay more in the pouch (since you stated it is normal size or not enlarged) and this will curb your appetite and give you saiety longer.  I know that is what Im feeling now since I've had it. The schlerotherapy helps in closing the stoma and the person should be able to lose weight. Schlerotherapy though is fairly new and not sure if available everywhere. Check to see if there are any drs in your area who does this. the schlerotherapy is done endoscopically and you're in the hospital for a couple hrs only. If you have any questions, ask.

 Hello mipo1,

I just had my RNY revised.  I went from the proximal, the traditional 100 cm bypassed (much like you) to the ERNY (extended RNY).   This is where they make the common channel anywhere from 50 cm to 100 cm for greater malabsorption.  This is very similar to the DS intestinal routing and in some case with even a shorter common channel.   I do know some have diarrhea issues, but so far I have not had this issue and even those who do suffer from it, from what I am told by my doctor, that it can be controlled by your diet.  I am about 2 weeks out from my revision.

Did you have difficulty getting the Ins coverage for your revision?  I have heard that some ins companies require almost nothing to approve except  weight gain and others require proof of a suture line failure and all the documentation that were needed for the original RNY .  

 My insurance would not give me prior authorization approval.  All they would tell me is that it is covered if it is medically necessary.  They did list a couple of requirements.  Now the odd thing was that if I had stayed in my home state they would make a determination and give me the prior approval I was looking for but because I chose to go out of state all they would tell me is that revision is covered under my policy, prior authorization is not required for out of state doctors and it has to be medically necessary.  This was a tough call for me and the doctors office.  But during my procedure, the doctor also repaired a hernia, fixed a partial intestinal blockage and fixed some adhesions.  Any one of these would have made a surgery medically necessary in my book.  I an only hope the insurance sees it the same way!

I'm a RNY/LAP patient...I had mine almost 2 years ago and the results were not up to par!

A WL surgeon (not the one who did it) looked over my records, including the operative report and said that the original surgeon didn't take as much intestine as he would have.

So..he suggested that I have a revision to take more intestine.

Right now I'm looking into a revision...but the suggestion he gave me makes me very nervous..I don't want to live in the bathroom..that's not worth it in my case.

At this point I have 100lbs to lose.

My internist suggested that I go to the sleeve...but that makes no sense to me!

I have appointments with 2 Bariatric surgeons one in Nov and the other in Dec  I suspect the reason I have never lost all the weight I should have is for the same reason,as you,  the original surgery did not bypass the standard amount of intestines.  I have never had any troublesome diarrhea but I never lost the final 40 pounds either.  I am hoping I can have the revision done whichever is the way it needs to be done. I know the endoscopic tightening of the anastamosis sites are NOT for people like me where the site far exceeds the normal dilation.  A very skilled and experienced surgeon did the Restore procedure and the procedure did not hold, it was not sucessful.   I would have tried Sclerotherapy but that is not available here and I suspect it would fail for the same reasons.  I will post what the 2 surgeons advise 

I would also recommend you speak with a surgeon who performs revisions to DS for an opinion on that. I'm not sure which 2 surgeons you have appointments with, but I know there are no reputable DS surgeons anywhere in New England. Maybe you could shcedule a phone consult with one in NY, PA, or NJ.

I'm hoping I can have the original surgery extended since it worked pretty well for so long.   I will be seeing Dr Lautz at Brigham and womens and Dr Burch at Boston Medical. 

I was wondering if anyone knew of any doctor's that performed the revisional surgeries in the Connecticut area? I have been looking into to this for some time now and would appreciate any help! Thanks a million!